“By the time mul­ti­ple scle­ro­sis (MS) is diag­nosed in chil­dren, it may be dif­fi­cult to pre­vent the dis­abil­i­ties and relaps­es that come with the dis­ease. In a new Yale School of Med­i­cine study, researchers exam­ined MRI brain scans to iden­ti­fy chil­dren at high risk of devel­op­ing MS before symp­toms appear, which may lead to ear­li­er diag­no­sis and treatment…the study of 38 chil­dren at 16 sites in six coun­tries showed that the MRIs can reveal changes in the brain asso­ci­at­ed with MS before the clin­i­cal symp­toms of the dis­ease appear in chil­dren.

The chil­dren in the study all under­went MRI scans for oth­er rea­sons, most com­mon­ly headache, but the MRIs unex­pect­ed­ly revealed signs of MS. Hav­ing MRI find­ings of MS with­out any symp­toms of the dis­ease has been termed radi­o­log­i­cal­ly iso­lat­ed syn­drome (RIS) and pre­vi­ous­ly had only been seen in adults.

“For the first time we have pro­posed a def­i­n­i­tion of RIS in chil­dren,” said lead author Naila Makhani, M.D., assis­tant pro­fes­sor of pedi­atrics and neu­rol­o­gy at Yale School of Med­i­cine. “Chil­dren with RIS may rep­re­sent a high-risk group of chil­dren that needs to be fol­lowed more close­ly for the lat­er devel­op­ment of clin­i­cal mul­ti­ple scle­ro­sis.”

Meth­ods: Clin­i­cal and radi­o­log­ic data were obtained from a his­tor­i­cal cohort of chil­dren with no symp­toms of demyeli­nat­ing dis­ease who had MRI scans that met the 2010 MRI cri­te­ria for dis­sem­i­na­tion in space for MS.

Results: We iden­ti­fied 38 chil­dren (27 girls and 11 boys) with RIS now being prospec­tive­ly fol­lowed at 16 sites in 6 coun­tries. The mean fol­low-up time was 4.8 ± 5.3 years. The most com­mon rea­son for ini­tial neu­roimag­ing was headache.

Con­clu­sions: We describe the clin­i­cal char­ac­ter­is­tics and out­comes of chil­dren with inci­den­tal MRI find­ings high­ly sug­ges­tive of CNS demyeli­na­tion. Chil­dren with RIS had a sub­stan­tial risk of sub­se­quent clin­i­cal symp­toms and/or radi­o­log­ic evo­lu­tion. The pres­ence of oligo­clon­al bands in CSF and spinal cord lesions on MRI were asso­ci­at­ed with an increased risk of a first clin­i­cal event.

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